A 65-year-old female on her routine examination was noted to have a pulsatile abdominal mass. She has been otherwise healthy with history of hypertension with no other history, except family history of father dying of ruptured abdominal aortic aneurysm. What are the acceptable reasons to operate on abdominal aortic aneurysms in 65-year-old female with 5-cm infrarenal aneurysm?

The current indication for repair of abdominal aortic aneurysm in female includes aneurysm size 5 cm in acceptable risk patient. A United Kingdom small aneurysm study has increased the size that could be observed to 5.5 cm in male while in female it is acceptable to treat aneurysm at 5 cm size for acceptable risk. Any aneurysm with associated complication should be treated; just the presence of intramural thrombus does not justify repair. Asymptomatic 5.5-cm aneurysm should be treated in all patients, male or female, at acceptable cardiac risk. Patients with 2-cm aneurysm of iliac artery without any symptoms and complications should be observed; as the risk of surgery is higher than risk of observation till they reach to 4 cm. In patients, not in child-bearing age, 1.5-cm splenic aneurysm could be observed.